Third Party Administrator Plan
WHAT IS A TPA?
TPA refers to a system of managing healthcare in which a third party (e.g. an HMO), ‘The Administrator’, is contracted to manage provider networks and medical claims for employees of the company, according to the client’s desired scope of cover.
The TPA scheme ensures prompt access to high quality medical care. It minimizes the financial impact of employee poor health, reduces the burden of health administration on the company, and ensures the containment of medical costs and the provision of management control.
• Scope of coverage
The scope of coverage is unlimited and is designed to meet the organization’s requirement and budget.
• Service Delivery
Subscribers will have access to additional services such as 24hr customer care, emergency ambulance and medical assistance services.
• Reduced Healthcare Cost
AXA Mansard health reimburses the health care provider for services provided at a pre-negotiated rate.
• Quality Management
AXA Mansard Health will ensure high quality care delivery by accrediting and monitoring contracted health providers. A second opinion will be required for non-emergency medical procedures.
• Reduced administrative burden
The HMO takes on the responsibility for administering medical benefits and payments.
• Nationwide Emergency Coverage
Subscribers are guaranteed access to our nationwide emergency care coverage.
• Utilization Reports
The HMO shall provide an annual analysis of the scheme’s operations and performance as well as periodic reports on payments, expenses and utilization trends.
• Funding and Payments
The administrator develops and administers a revolving medical claims fund (deposit) which allows for cash flow advantage. The TPA system eliminates the issue of premiums but embraces payments for only genuine medical services rendered.
The subscribing organisation sets the financial, dependents and health care provider limits according to the company’s condition of service.